颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义

目的　通过对尸体标本的颈动脉分叉区域内的神经、血管进行解剖研究,为安全有效地开展颈动脉内膜剥脱术提供形态学依据及解剖学基础。 方法 选取20例（40侧）无明确心、脑血管疾患的尸体解剖标本（男11例、女9例）,采取颈动脉内膜剥脱术式入路对颈动脉分叉区域内的神经、血管进行解剖研究,明确血管和神经的形态学及结构特点。 结果 颈总动脉分叉部形态可分为Ⅰ、Ⅱ、Ⅲ型,分别占比为10%、52.5%、37.5%。分叉位置以甲状软骨为界,左侧颈总动脉分叉部高度在其上缘以上、平上缘和上缘以下的占比分别为55%、37.5%、7.5%;相较之下右侧分别为62.5%、27.5%、10%。男性颈总、颈内、颈外动脉内径均大于女性（P<0.05）;男性颈动脉分叉角度大于女性（P<0.05 ）。双侧颈总、颈内、颈外动脉内径相比无统计学意义（P>0.0 5）;左侧颈动脉分叉角度大于右侧（P<0.05）。 结论　通过对颈动脉分叉区域内的神经、血管进行解剖研究,对颈动脉内膜剥脱术术中血管与神经的保护具有重要的临床意义。     

右颈总动脉异常分支伴甲状腺峡部缺如

我们在解剖标本中,发现一男尸,约50岁,身高165cm,颈部皮肤未见切口及手术疤痕,见其右侧颈总动脉发出甲状腺上动脉直至甲状腺侧叶上端并伴有甲状腺峡部缺如,现报道如下:该尸体右侧颈总动脉在舌骨体平面才分为颈内动脉和颈外动脉,比左侧颈总动脉分支高2.49cm。而甲状腺上动脉却在甲状软骨右板右上方,距下颌下腺下缘0.67cm处直接由颈总动脉发出,其起始部外径为0.26cm。起始后在胸锁乳突肌深面直接跨过甲状软骨右板沿胸骨甲状肌、肩胛舌骨肌、胸骨舌骨肌深面斜行向下至甲状腺侧叶尖端处分为3条终支,供应甲状腺。而左侧颈总动脉分支及甲状腺上动…     

胸腺动脉来源于左甲状腺上动脉一例

在解剖一具未成年男性尸体颈部时,见左甲状腺上动脉较右侧支粗大,该动脉一直延伸至胸腔达胸腺左叶.该动脉由左侧颈外动脉起始处附近发出,沿甲状腺表面下降,经胸骨柄后方入胸腔达胸腺左叶.在胸腺左叶中下1/3交界处分出两终支,穿入胸腺实质.该动脉沿途分支至胸锁乳突肌,舌骨下肌群及甲状腺左叶.动脉起始处外径2.4mm,在距该动脉起点1.6cm处,对称发出胸锁乳突肌支(起点处外径1.12mm)及甲状腺上后支(起点处外径1.14mm);沿途还发出甲状腺上前支,起始处外径0.9mm,胸骨甲状肌支.起始处外径0.8mm.本干延至甲状腺左叶下极处,外径1.5mm;至胸腺上极外径1.3mm.自甲状腺右叶下极至胸腺上极处,干长1.95cm.至胸腺左叶中、下1/3交点分出两终支处,干长8.03cm.本例右侧胸腺动脉来自右侧胸廓内动脉.     

甲状腺上动脉变异一例

<正>在解剖1具成年男性尸体颈部时,观察到右侧甲状腺上动脉罕见变异(见附图),现报道如下。右侧甲状腺上动脉(外径2.02mm)在颈外动脉起始     

胎儿甲状腺动脉解剖结构及其意义

目的　利用血管铸型标本和三维重建血管技术探讨胎儿甲状腺动脉的解剖结构及其应用价值。 方法 经颈总动脉和锁骨下动脉灌注填充剂,解剖观察及测量17例18~37周胎儿的甲状腺动脉;将CT扫描铸型标本数据导入Mimics 21.0软件进行甲状腺动脉三维重建。 结果 胎儿甲状腺上动脉可起源于颈外动脉第1分支（79.4%）,或起源于颈总动脉（14.7%）,或起源于颈总动脉分叉处（5.9%）;胎儿甲状腺下动脉可起源于甲状颈干（76.5%）,或起源于锁骨下动脉（23.5%）。胎儿甲状腺动脉分支及分布恒定。与成人甲状腺动脉相比,胎儿甲状腺动脉起始位置无明显差异;其分支及分布存在明显差异。 结论 了解胎儿甲状腺动脉的起始位置及分支分布特点,对宫内胎儿发育研究或新生儿临床手术具有指导实践基础。     

喉上神经外支和甲状腺上动脉的应用解剖

目的　解剖并观察喉上神经外支（external laryngeal nerve, ELN）和甲状腺上动脉（superior thyroid artery,STA）之间的比邻关系,为手术中保护ELN提供解剖学基础。 方法　成年尸体标本57具（114侧）,在6倍大视场显微镜下解剖并观察ELN、STA的比邻关系。 结果　本组标本中颈交感链（cervical sympathetic chain,CSC)与ELN吻合成袢（CSC-ELN loop)者,占78.9% （90侧）。在27.7%（25侧）低位CSC-ELN loop中,血管和神经的位置关系可分为4类：①STA分支与CSC-ELN loop重叠;②STA腺支穿过CSC-ELN loop;③CSC-ELN loop环甲肌支与STA喉支伴行;④STA的分支与CSC-ELN loop分支相互交叉。 结论　STA与CSC-ELN loop之间的关系十分复杂。有鉴于此,在甲状腺和/或颈部手术中,我们特提出两个手术保护措施：①应单支游离并结扎STA;②在处理STA的前内侧分支时,应注意避免损伤ELN/CSC-ELN loop的环甲肌支。     

肩胛上动脉起始变异一例

在解剖1例男尸时,发现肩胛上动脉起自颈横动脉浅支,现报道如下：     

甲状腺上动脉应用解剖

27具成人尸体股动脉红色乳胶灌注 ,10 %福尔马林固定。在手术显微镜下解剖甲状腺上动脉 ,观察该动脉的起源、分支、毗邻等形态特点 ,测量脉管、神经的外径、长度 ,讨论了这些结构临床意义     

异常闭孔动脉的形态特点及其临床意义

目的　观察异常闭孔动脉的走形、分布,并对其盆内段进行测量和定位,为腹股沟区相关手术提供可靠的解剖学基础。 方法　解剖研究37侧成人骨盆标本,对闭孔动脉进行观测和分类,并测量闭孔动脉盆内段长度,起始端外径,闭孔管处外径,以及闭孔动脉入闭孔处和髂前上棘与耻骨联合连线中点的距离。 结果　在37侧标本中,异常闭孔动脉出现率为18.92%。异常闭孔动脉与腹壁下动脉共干（1.57±0.12）cm发出,盆内段平均长度（4.05±0.49）cm,起始处平均外径（2.52±0.87）mm,闭膜管处闭孔动脉平均外径（2.14±0.72）mm,入闭孔处和连线中点的距离（3.63±1.29）cm。异常闭孔动脉多与腹壁下动脉共干,之后绕股环或跨过股环,紧贴盆壁下降至闭孔处。 结论　正是由于异常闭孔动脉的特殊性质,在腹股沟区及骨盆、髋区骨折固定手术,甚至肿瘤治疗、淋巴结清除术中,术者当引起重视。     

甲状腺最下动脉的应用解剖

观察155例尸体,甲状腺最下动脉出现率为13.5%,头臂干为常见起点。占73.9%。根据该动脉的分支、行径和供应甲状腺情况分为混合型(56.5%)、右优势型(30.4%)和左优势型(13.0%)。该动脉在气管前方上行,特别是混合型于气管前正中和左优势型斜越气管前方,在颈前部手术时应充分注意该动脉的存在。     

垂体上动脉的显微外科解剖及其临床意义

目的：为探讨垂体上动脉在鞍区显微外科手术时的意义,以及与颈内动脉眼动脉段动脉瘤发生的关系。方法：研究了２４例颅脑４８侧颈内动脉发出的垂体上动脉的显微外科解剖。结果：垂体上动脉起自颈内动脉眼动脉段,有１～４支,可分为单支型（３７．５％）和多支型（６２．５％）。平均支数为２．２±１．０支,直径为０．２６±０．１（０．１６～０．４８）ｍｍ。起点在颈内动脉起点远侧５．８±２．０（３．６～１８．６）ｍｍ。该动脉起始后向内、后、上行至视交叉下前面,发出分支与对侧垂体上动脉和后交通动脉分支相互吻合,构成漏斗周围吻合网,分布至漏斗、垂体、视交叉。且有一恒定分支折返前行至视神经,它对视神经的血液供应起着非常重要的作用。结论：该动脉的显微解剖,对理解颈内动脉瘤的发生以及鞍区肿瘤的外科手术有重要的临床意义。     

颈动脉的形态与动脉粥样硬化的解剖学观测

目的研究颈动脉的形态与动脉粥样硬化的情况,为颈总、颈内动脉狭窄的诊治提供形态学基础。方法解剖观测成尸30(男24、女6)侧颈动脉,观测颈动脉的形态及动脉粥样硬化情况。结果①颈总动脉中段外径,左侧(8.75±1.56)mm;右侧(8.31±0.99)mm。②颈内动脉根部外径,左侧(8.15±1.42)mm;右侧(7.51±1.63)mm。③颈外动脉中段外径,左侧(4.87±1.09)mm;右侧(4.39±0.89)mm。④颈动脉粥样硬化发生率占60%(18侧),其中颈内动脉根部四壁明显动脉硬化,内腔直径1.6mm严重狭窄1侧,占总数的3.33%。结论颈动脉粥样硬化发生率最高为颈动脉窦,占颈动脉硬化标本的100%,可致颈内动脉内腔狭窄。     

Thyrolingual trunk arising from the common carotid artery a case report

During a cadaver dissection in the anatomy department of the University of Liege, Belgium, an anatomic variation of the superior thyroid and lingual arteries was observed on the right side in a 68-year-old woman. Both arteries arose from a common trunk located 30 mm beneath the carotid bifurcation. After a 5.2 mm course, the thyrolingual trunk divided into superior thyroid and lingual arteries which followed an unusual course towards their respective organs. Knowledge of this anomaly is important for those who are involved with neck surgery and anatomy.     

Anatomic evaluation of the carotid artery bifurcation in cadavers: implications for open and endovascular therapy

Knowledge of carotid bifurcation (CB), common carotid artery (CCA) and its branches and their recognition during diagnostic imaging are also important for vascular surgical procedures in the region, such as carotid endarterectomy or radical neck dissection, catheterization and aneurysms. The surgical anatomy of the carotid arteries was studied in 20 cadavers. Micrometric values of the CB and its relation with surrounding structures, measurements belonging to the external carotid artery (ECA) and internal carotid artery (ICA), and metric data, such as lower face including the greater horn, laryngeal prominence have been evaluated by making linear measures. The diameter of the CCA at the CB under 2 cm and CB diameter was measured as 8.1 +/- 2.24 mm and 12.79 +/- 2.87 mm, respectively. Evaluating data related to the ICA and the ECA in samples, the aspect was measured the ICA and the ECA in the CB discrimination point as 21.52 +/- 20.53 degrees . In the most location of the ECA origin according to the ICA has been determined as medial position in 35 specimens. The origin of the superior thyroid artery (STA) was found to be at the same level with the CB in 40% and below it in 25% specimens. This study has provided measured objective criteria for the arterial features of the neck region, which are crucial during surgery. The origins of the branches of the CCA act as key landmarks for adequate and appropriate placement of the cross-clamp on the carotid arteries.     

Variant origin of the superior thyroid artery in a Kenyan population

Variant anatomy of the superior thyroid artery is important during surgical procedures, interpretation of angiograms, and interventional radiography in the neck. Pattern of the variations shows population differences but there is no data from the Kenyan population. This study therefore investigated the variations in origin of the superior thyroid artery in a Kenyan population. Forty six necks (36 males and 10 females) from 46 cadavers of black Kenyans in Department of Human Anatomy University of Nairobi, Kenya were bilaterally dissected to expose the origin of the superior thyroid artery. Pattern of origin of the vessel was determined on both sides in males and females. It originated from the external carotid artery common carotid artery and linguo-facial trunk in 80%, 13%, and 6.5% of the cadavers respectively on the right side. All but one of the superior thyroid arteries were ventral branches. There was asymmetric origin in 6.5% of cases. Origin from the common carotid artery was associated with high carotid bifurcation. Nearly 20% of superior thyroid arteries showed variant origin. Of these, 6.5% arose from the linguo-facial trunk, much higher than in the Caucasian and Oriental populations. Origin from common carotid artery is substantially lower than prevailing figures from other populations. These findings support ethnic variations. Preoperative angiographic evaluation is recommended.     

Clinically relevant variations of the superior thyroid artery: an anatomic guide for surgical neck dissection

The superior thyroid artery (STA) is the dominant arterial supply of the thyroid gland, upper larynx and the neck region. The knowledge of variations in possible patterns of origin, courses, and branching pattern of the STA is also important for surgical procedures in the neck region, such as emergency cricothyroidotomy, radical neck dissection, catheterization, reconstruction of aneurysm and carotid endarterectomy. The surgical anatomy of the STA was studied in 20 adult Anatolian preserved cadavers between the age of 40 and 70 years. The outer diameter of the STA origin was observed to be 3.53 ± 1.17 mm. The location of the origin of the STA according to the carotid bifurcation was evaluated as above (25%), below (35%) and at the same level (40%). The distribution patterns of the STA were classified into six types depending on the branching pattern. The outer diameter of the infrahyoid branch, superior laryngeal artery, sternocleidomastoid artery and cricothyroid branch at their origins were observed to be 1.13 ± 0.14, 1.42 ± 0.47, 1.54 ± 0.96 and 1.30 ± 0.41 mm, respectively. Typical and variant glandular branching patterns were observed in 85 and 15% of the specimens, respectively. The outer diameters of anterior, anteromedial, anterolateral and posterior glandular branches were measured as 2.05 ± 0.46, 1.41 ± 0.43, 1.51 ± 0.41 and 1.73 ± 0.53 mm, respectively. It is necessary to understand the surgical anatomy of the STA to carry out successful radical neck dissection and to minimize postoperative complications in a bloodless surgical field.